Systems for monitoring lesion size trends and methods of operation thereof

ABSTRACT

A medical imaging system configured to receive first image information corresponding with one or more images acquired at a first time, the one or more images including a lesion; receive second image information corresponding with one or more images of the lesion acquired at another time; render volumes of the lesion for each image; and overlays the two volumes. Other factors and/or indicators, such as vascularization indicators, may be calculated and compared between the first image information and second image information.

The present system relates generally to a medical imaging system andmore particularly, to an ultrasound imaging system with an imageevaluation technique, and a method of operation thereof

An important factor in the treatment of cancer is the ability for aphysician to determine the efficacy of treatment. Efficacy of atreatment may be defined by slowing or reduction in tumor growth,reducing tumor vascularization, or other biological parameters. When aphysician cannot accurately determine the efficacy of treatment, acancer patient may be needlessly subjected to ineffective treatmentswith detrimental side-effects that reduce quality of life. Poor efficacydetermination may also cause a delay in transferring the patient to atreatment that may be more effective at treating the patient's cancer.This delay could negatively impact the patient's outcome.

Efficacy of tumor treatment is often evaluated using non-invasiveimaging methods as repeated surgical investigations of the tumor sitemay be impractical or impossible. Imaging methods that do not requireionizing radiation, such as ultrasound imaging, may be advantageous whenpatients require multiple evaluations. In order for a physician to drawconclusions about tumor growth or reduction, it is advantageous to haveconsistent measurements from each point in time to each successive pointin time when a new image is acquired. Inconsistency in measurementscould be introduced by individual variation, rotations or changes inacquisition parameters for the acquired view, changes in physicians, orother factors. These inconsistencies may hinder the physician's abilityto evaluate efficacy of tumor treatment.

According to one illustrative embodiment of the invention disclosed, amedical imaging system configured to receive first image information andsecond information, e.g., of a lesion over time, render a first volumeand a second volume based on the image information, and overlay thefirst and second volumes. The system may be further configured todetermine coordinate information corresponding to location informationin the image information. The coordinate information may be based uponcalculated image contour information. The image information may furtherinclude vascular information of the lesion. The controller may beconfigured to determine vascular indexes based on the vascularinformation. The vascular index of the first volume and the secondvolume may be compared by the controller. The vascular index may bedefined as the percentage of the volume that includes blood flow. Thevascular information may be derived from Doppler information. Theimaging system may further comprise an ultrasound probe with which toacquire the image information.

According to another disclosed embodiment of the present invention, animage processing method may include receiving first image information ata first time and second information at a second time, the first andsecond image information including data corresponding to a lesion in atissue; rendering a first volume and a second volume of the lesion fromthe image information; and overlaying the second volume and the firstvolume of the lesion, wherein the volumes can be defined by wire framesor meshes generated by an imaging system. The method may also includethe act of acquiring image information from an ultrasonic probe. Theimage processing method may include acquiring a sequence of images overtime to identify changes in lesion volume. The image processing methodmay include taking a ratio of the first and second volumes of a lesion,e.g., a tumor. The image processing method may further includecalculating the surface area of the first and second volumes. The imageprocessing method may then plot the surface area of the first and secondvolumes with respect to time, and may further calculate a rate of changeof the surface area of the volumes between the first and second times.The image processing method may render a wire frame or a surface for thevolumes.

According to another aspect of the present invention, there is disclosedan application embodied on a non-transitory computer readable mediumconfigured to receive image information from an ultrasonic probe. Theapplication may include code which causes a controller in an imagingsystem to receive first image information and second image information,the first and second image information including data corresponding to alesion in a tissue; render first and second volumes from the imageinformation of the lesion; and overlay the second volume on the firstvolume. Moreover, the code may cause the controller to calculate anindicator for the first and second volumes. The controller may furthercalculate the difference between the indicator for the first volume andthe indicator for the second volume. The indicator may be the vascularindex.

In the Drawings:

FIG. 1A is a schematic view of an embodiment of an image-capturingsystem according to the present system.

FIG. 1B is a schematic view of an embodiment of an ultrasound imagingsystem according to the present system.

FIG. 2A is a flow chart illustrating a process performed according to anembodiment of the present system.

FIG. 2B is a flow chart illustrating another process performed accordingto an embodiment of the present system.

FIG. 3 is a screen shot illustrating an image display according to thepresent system.

FIG. 4 is a screen shot illustrating another image display according tothe present system.

FIG. 5 is a screen shot illustrating a further image display accordingto the present system.

The following description of certain exemplary embodiments is merelyexemplary in nature and is in no way intended to limit the invention orits applications or uses. In the following detailed description ofembodiments of the present systems and methods, reference is made to theaccompanying drawings which form a part hereof, and in which are shownby way of illustration specific embodiments in which the describedsystems and methods may be practiced. These embodiments are described insufficient detail to enable those skilled in the art to practice thepresently disclosed systems and methods, and it is to be understood thatother embodiments may be utilized and that structural and logicalchanges may be made without departing from the spirit and scope of thepresent system.

The following detailed description is therefore not to be taken in alimiting sense, and the scope of the present system is defined only bythe appended claims. The leading digit(s) of the reference numbers inthe figures herein typically correspond to the figure number, with theexception that identical components which appear in multiple figures areidentified by the same reference numbers. Moreover, for the purpose ofclarity, detailed descriptions of certain features will not be discussedwhen they would be apparent to those with skill in the art so as not toobscure the description of the present system.

In one embodiment, there is provided a system, application, and/ormethod for systematically performing a medical assessment of a lesionsuch as a solid tumor at multiple points in time, so as to standardizemedical image reporting, which may reduce evaluation times and errors.Accordingly, costs for acquiring, reporting, and/or evaluating medicalimages may be reduced. Evaluation of treatment efficacy may also beimproved.

A schematic view of an embodiment of an image-capturing system 100according to one embodiment of the present system is illustrated in FIG.1A. The image-capturing system 100 may include one or more of acontroller 102, a memory 104, a display 106, a modem 108, an audio inputdevice (MIC) 110, an audio output device (SPK) 112, an image acquisitiondevice (IAD) 114, an image acquisition control (IAC) device 116, a userinterface (UI) 118, a network 120, a remote storage device 122, and aremote device or terminal 124.

The controller 102 controls or is configured to control the overalloperation of the image-capturing system 100 and may include one or morecontrollers which may be located at the same location or at differentlocations. For example, one or more of the controllers may be located atthe remote device 124. Accordingly, certain actions performed by one ormore of the processes of the present invention may be performed at theremote device.

The memory 104 may interface with the controller 102 and may store or beconfigured to store programs and data which may be read and/or stored bythe image-capturing system 100. The memory 104 may include one or moreof a hard disc, a read-only memory (ROM), a random-access memory (RAM),a flash drive, an optical drive, and/or another suitable memory device.Further, the memory 104 may include different types of memory and may belocated at a plurality of locations. The memory may include the programsand/or data created by operation of the present systems, devices, and/ormethods.

The display 106 may display information under the control of one or morecontrollers such as, for example, the controller 102. The display 106may include any suitable display such as, for example, cathode ray tubes(CRTs), liquid crystal displays (LCDs), plasma displays, touch screens,etc. The display 106 may include multiple displays which may be locatedat different locations. The display 106 may also receive user inputs.

The modem 108 may operate under the control of the controller 102 andmay transmit and/or receive data to/from the controller 102 to variouslocations via, for example, the network 120. The modem 108 may includeany suitable modem or modems and may communicate via a wired and/or awireless link.

The audio input device 110 (MIC) may include any suitable device forinputting audio information, such as, for example, a microphone and/ortransducer. The audio input device 110 may transmit received audioinformation to the controller 102 via, for example, a coder/decoder(CODEC). The audio input device 110 may also be located at a remotelocation and may transmit information via, for example, the network 120.The audio input device 110 may receive audio inputs from, for example, auser. A voice recognition program may then translate these commands foruse by the controller 102. A translation program such as, for example, aspeech-to-text converter, may be used to convert sound information(e.g., a user's voice, a command, etc.) into text or other data.

An audio output device 112 (SPK) may output audio information for auser's convenience. The audio output device 112 may include a speaker112 and may output audio information received from, for example, thecontroller 102, via, for example, the CODEC. Further, a translationprogram may translate a parameter (e.g., text, data, etc.) to bevisually output so that the parameter can be output via the audio outputdevice 112.

The image acquisition probe 114 may obtain desired information under thecontrol of the controller 102 and transmit this information to thecontroller 102 where it may be processed. The image acquisition probe114 may include one or more transducer arrays, etc. For example, thepresent system may include a transducer such as, for example, a C5-1transducer by Philips®.

The image acquisition control (IAC) device 116 may be controlled by thecontroller 102 and may include stabilization control devices (e.g.,array stabilizers, etc.) which may control the position of the imageacquisition probe (IAD) 114. For example, the IAC device 116 may includeone or more devices to control the yaw, pitch, and/or roll of, forexample, one or more transducer arrays relative to a handle, etc.Accordingly, the IAC device may control the position of the one or moretransducer arrays about an x, y, or z axis and/or reduce undesiredharmonics, vibration, etc. Further, the IAC device 116 may include acounter balance, a motor, a control system, etc., to control vibration,etc., of the one or more transducer arrays.

The user interface (UI) or user input device 118 may receive user inputsand transmit these inputs to, for example, the controller 102. The userinput device 118 may include any suitable input device which can receivea user input, such as, a keyboard, a mouse, a touch pad, a track ball, apointer, a digitizer, a touch screen, a finger-print reader, etc.Further, the user input device may include a biometric reader forinputting biometric information such as, for example, the fingerprintreader, an iris reader, etc.

The network 120 may include one or more of a local area network (LAN), awide area network (WAN), the Internet, an intranet, a proprietarynetwork, a system bus, and/or other transmission devices (active and/orpassive) which may transmit information between various devices of theimage-capturing system 100. The network 120 may operate using anysuitable transmission scheme.

The remote storage device 122 may include any suitable memory devicewhich can store information as required by the image-capturing system100. Accordingly, the remote storage device 122 may include memorydevices such as those described with reference to the memory 104.Further, the remote storage device may include a redundant array ofindependent disks (RAID) and/or other storage configurations. Moreover,the remote storage device 122 may include, for example, a storage areanetwork (SAN). The remote storage device 122 may transmit/receiveinformation to/from the controller 102 via the network 120 and/or themodem 108.

Referring to FIG. 1B, an ultrasound imaging system constructed inaccordance with the principles of the present invention is shown inblock diagram form. In the ultrasonic diagnostic imaging system of FIG.1B, a transducer array 10′ is provided in an ultrasound probe 10 fortransmitting ultrasonic waves and receiving echo information. Thetransducer array 10′ is preferably a two dimensional array of transducerelements capable of scanning in three dimensions, for instance, in bothelevation and azimuth about the location of the mitral valve, for 3Dimaging. The transducer array is coupled to a microbeamformer 12 in theprobe which controls transmission and reception of signals by the arrayelements. The microbeamformer is coupled by the probe cable to atransmit/receive (T/R) switch 16 which switches between transmission andreception and protects the main beamformer 20 from high energy transmitsignals. The transmission of ultrasonic beams from the transducer array10 under control of the microbeamformer 12 is directed by the transmitcontroller 18 coupled to the T/R switch and the beamformer 20, whichreceives input from the user's operation of the user interface orcontrol panel 38. One of the functions controlled by the transmitcontroller is the direction in which beams are steered. Beams may besteered straight ahead from (orthogonal to) the transducer array, or atdifferent angles for a wider field of view. The partially beamformedsignals produced by the microbeamformer 12 are coupled to a mainbeamformer 20 where partially beamformed signals from the individualpatches of elements are combined into a fully beamformed signal.

The beamformed signals are coupled to a signal processor 22. The signalprocessor 22 can process the received echo signals in various ways, suchas bandpass filtering, decimation, I and Q component separation, andharmonic signal separation. The signal processor may also performadditional signal enhancement such as speckle reduction, signalcompounding, and noise elimination. The processed signals are coupled toa B mode processor 26 and a Doppler processor 28. The B mode processor26 employs amplitude detection for the imaging of structures in the bodysuch as a tumor. The Doppler processor 28 processes temporally distinctsignals from tissue and blood flow for the detection of the motion ofsubstances such as the flow of blood cells in the image field. Thestructural and motion signals produced by the B mode and Dopplerprocessors are coupled to a scan converter 32 and a multiplanarreformatter 44. The scan converter arranges the echo signals in thespatial relationship from which they were received in a desired imageformat. For instance, the scan converter may arrange the echo signalinto a two dimensional (2D) sector-shaped format, or a pyramidal threedimensional (3D) image. The scan converter can overlay a B modestructural image with colors corresponding to motion at points in theimage field corresponding with their Doppler-estimated velocities toproduce a color Doppler image which depicts the motion of tissue andblood flow in the image field. The multiplanar reformatter can convertechoes which are received from points in a common plane in a volumetricregion of the body into an ultrasonic image of that plane, as describedin U.S. Pat. No. 6,443,896 (Detmer). A volume renderer 42 converts theecho signals of a 3D data set into a projected 3D image as viewed from agiven reference point, e.g., as described in U.S. Pat. No. 6,530,885(Entrekin et al.) The 2D or 3D images are coupled from the scanconverter 32, multiplanar reformatter 44, and volume renderer 42 to animage processor 30 for further enhancement, buffering and temporarystorage for display on an image display 40.

In accordance with the principles of the present invention, blood flowvelocity values produced by the Doppler processor 28 are coupled to alesion vascularization processor 34. The lesion vascularizationprocessor operates as described below to produce a measure of the bloodflow in or around a tumor being imaged by the system. The lesionvascularization processor may receive input from the user control panel38, such as an initial estimate of the location of the tumor. Outputdata from the lesion vascularization processor is coupled to a graphicsprocessor 36 for the reproduction of output data from the processor withthe image on the display 40. The graphics processor 36 can also generategraphic overlays for display with the ultrasound images. These graphicoverlays can contain standard identifying information such as patientname, date and time of the image, imaging parameters, and the like. Forthese purposes the graphics processor receives input from the userinterface 38, such as a typed patient name. The user interface is alsocoupled to the transmit controller 18 to control the generation ofultrasound signals from the transducer array 10′ and hence the imagesproduced by the transducer array and the ultrasound system. The userinterface is also coupled to the multiplanar reformatter 44 forselection and control of a display of multiple multiplanar reformatted(MPR) images which may be used to quantify blood flow in the MPR imagesof the tumor in accordance with the present invention as describedbelow.

A process for capturing images and analyzing lesion volumes according toan embodiment of the present system will now be described. A flow chartcorresponding to a process according to an embodiment of the presentsystem is shown in FIG. 2A. A process 150 may be controlled by one morecomputers communicating directly and/or over a network. The process 150,as well as other processes according to the present methods, may beperformed by execution of instructions embodied, e.g., on a computerreadable medium (such as the memory 104) by a processor, such as thecontroller 102 or other similar component of a system described herein.The processor or controller 102 may be an application-specific orgeneral-use integrated circuit(s). Further, the processor 102 may be adedicated processor for performing in accordance with the present systemor may be a general-purpose processor wherein only one of many functionsoperates for performing in accordance with the present system. Theprocessor 102 may operate utilizing a program portion, multiple programsegments, or may be a hardware device utilizing a dedicated ormulti-purpose integrated circuit.

The process 150 may include one or more of the following steps, acts oroperations. Further, one or more of these steps, acts, or operations maybe combined and/or separated into sub-steps, sub-acts, orsub-operations, if desired. In act 152, a monitoring process such as,for example, a tumor monitoring automation process begins and proceedsto act 154.

In act 154, an image acquisition process is performed to acquire currentimage information. All necessary images should be acquired in act 154,however, act 154 may be repeated at other times to acquire othernecessary images. After completing act 154, the process continues to act156.

In act 156, the current image information (e.g., an image volume) may bestored in, for example, a local memory, a database, or other suitablememory. After completing act 156, the process may continue to act 158.

In act 158, the process may use an image processing routine toanalyze/compare the current image information and the previous imageinformation that was acquired previously (e.g., last month, last year,etc.). For example, according to the process, a user may measure lesionsautomatically by using an auto stack contour routing method (e.g., inQLAB™) or manually (e.g., by using a tracing function in QLAB™). Themeasurements, location, and/or contours of lesions may then be definedand/or recorded by generating a wire frame or mesh of the volume andassigning, for example, x, y, and/or z coordinates to user-definedpoints of interest (e.g., blood vessels). The x, y, and/or z coordinatesof edges, contours, or user defined points of interest may be locationinformation associated with the acquired image. This information maythen be stored in a database or other suitable area for later use.

This information may then be used at a later time, such as, for example,when conducting a follow up imaging technique. For example when apatient has a successive tumor monitoring examination in which currentimage information is acquired, the image information acquired in one ormore previous examinations, may then be retrieved or downloaded from thememory 104 or storage 122, and analyzed using any suitable imageprocessing application, such as, for example, QLAB™, which may determinecertain imaging parameters such as depth, focal zone locationcompression, contours, and/or x, y, and z coordinates, velocityinformation from Doppler techniques, echo intensity. One or more of suchimaging parameters may be matched in a current examination to similarimaging parameters used in one or more previous tumor monitoring exams.This process may be performed by a user or by the system automatically.Accordingly, the system may access image parameter information to obtaininformation related to image parameters used in one or more previoustumor monitoring exams. An auto stack contours method (e.g., in QLAB™)may be applied to define tumor volumes across multiple images acquiredin different planes in the same monitoring exam.

In accordance with an embodiment of the invention, location informationsuch as, for example, x, y, and/or z coordinates of certain locations(e.g., corresponding with, for example, lesions, blood vessels, etc.) ofimage information corresponding with the previous examination, may becompared with corresponding information of image information associatedwith the current examination. For example, the wire frame of the volumefrom the previous examination may be embedded in the visualized volumeof the current examination or vice versa. This may aid the operator inmaking consistent measurements across time, and increase confidence inthe evaluation. An auto correlation and/or superimposition of additionalimage information may as also be performed.

After act 158, the process may continue to act 160.

In act 160, the process may display a corresponding report for a user'sconvenience. When the report is displayed, a user may enter additionaltext and/or annotations as necessary.

According to the present system, the system may extrapolate numericvalues for the current and/or previous measurements in any positiondefined. The corresponding measurements may then be stored in the x, y,and/or z format during the analysis of the auto stack contours. Further,a “manual override” option may be provided for the user to enterinformation corresponding to a lesion such as, for example, lesiondefinition, lesion identification, etc., at any time.

After completing act 160, the process may continue to act 162.

In act 162, the process may generate a report and/or save the imageinformation and any corresponding information (e.g., patient and probeorientation markers, lesion locations, lesion definitions, userinformation, date information, patient information, etc.) for later useand/or analysis, in any suitable location such as, for example, adatabase, etc.

After completing act 162, the process may continue to act 164.

In act 164, a physician or other user may further analyze the acquiredimages using a suitable image processing program such as, for exampleQLAB™. The physician may retrieve and display two or more acquired tumorvolume images. The images may have been acquired at different points intime of the same tumor. The physician may use the image processingprogram to render a surface or a wire frame to the tumor volumes if suchrenderings were not already generated and saved in a suitable location.The rendering may also include demarcation of blood vessels in the tumorvolume or proximate to the tumor volume. This may allow the physician toview the effect tumor treatment has on the vascularization of the tumor.The physician may view the volumes side-by-side. However, it may beadvantageous to overlay the tumor volume images, rendered surfaces, wireframes, or combinations thereof

FIG. 2B illustrates a flow chart of a process 200 of overlaying thetumor volume images according to an embodiment of the present system.The first image information is received at act 205, and the second imageinformation is received at act 210. Although shown sequentially, theimage information may be loaded in either order or in parallel. Theimages are then overlaid at act 215. Location information included inthe image information may be used during act 215 to align certainlocations that may be common between the two images such as bloodvessels and/or operator-defined points of interest. The process 200 maybe incorporated into the image processing program previously describedor may be performed by a separate software program or processor.Optionally, the process illustrated in FIG. 2 may be performed at act158 in FIG. 1. The physician may also be able to independently rotatethe images to manually correct for differences in acquisition angles.The physician may be able to adjust the alpha blending of the images(i.e., the opacity of each image) to enhance comparison between volumes.The physician may then observe changes in tumor shape, volume, andvascularization over time.

The physician may use the suitable image processing program to quantifytumor volume, tumor surface area, and ratio calculated volumes orsurface areas between images. For example, with the lesionvascularization processor 34, the image processing program may alsocalculate the number of pixels within the volume that have blood flow(the “vascular index”) and/or the velocity of blood flow (the “flowindex”). These measurements may be considered vascularizationindicators. The presence of blood flow is determined from a shift in thewavelength of the reflected signal in reference to the transmittedsignal due to the Doppler Effect. The magnitude of the shift allowsdetermination of the direction and velocity of flow. The suitable imageprocessing program may plot the calculated values from each image forthe indicators over time so that the physician may view trends in theseindicators over time. Trends may include, for example, rates of changein an indicator and total change over time.

The visual analysis by the physician and the quantitative valuescalculated for volume, surface area, and vascularization indicators mayassist the physician in more accurately evaluating the efficacy of tumortreatment and plan future treatment. For example, by presentingside-by-side 3D views, taken at different times during a treatment, andthat are enhanced with wire frames of the tumor, the present systems andmethods can aid physicians in making consistent tumor measurements overtime, thereby increasing confidence in the evaluation. Furthermore, theability to view changes in vasculature over time may also assistphysicians in determining which vessel branch is providing the bloodsupply to the affected tumor segment. The physician may then be able toprovide more targeted drug delivery, which may be more effective. Forexample, a physician compare two wire frame frames and determine whichsegment(s) of the tumor are shrinking or growing. By correlating thevascularization information, the physician could also identify whichvessel(s) are providing blood supply to the affected tumor segment andthen alter treatment accordingly.

The ability to visualize and quantify changes in vasculature features ina lesion may become increasingly important as more treatments aredeveloped that target vascular formation in tumors. For example,anti-angiogenic therapies may have early effects on the vasculature wheneffective before changes in tumor volume may be detected. Changes incertain vascular features may also be an indicator of tumoraggressiveness and patient prognosis in some cases.

A screen shot 300 illustrating an image display according to anembodiment of the present system is shown in FIG. 3. The screen shot 300illustrates a screen which may be displayed using data which maycorrespond with a tumor. The screen shot 300 may also correspond withdata that may be saved in a report. This data may include acquired imageinformation, notes, annotations, measurements, day, date, time,patient's identification (ID), such as, for example, a number, a name,etc., medical professional data (e.g., sonographer's name, doctor'sname, medical center's name, location, patient biometric information,etc.), viewing/editing history, change information, etc. The screen shot300 may include one or more information areas in which user information,location (e.g., “Test Hospital”), day, date, time, type of exam (e.g.,“TMR”) and/or certain test parameters are displayed. (Not shown) Animage viewing area may display one or more images such as, for example,images 305 and 310 which may have been acquired during a process (e.g.,an image acquisition process, a download process, etc.) of an embodimentof present system. Image 305 may be an image of a wire frame renderedfor a tumor volume measured at a time before a treatment wasadministered. Image 310 may be an image of a wire frame rendered for thetumor acquired at a time after or during the treatment. Reconstructionplanes 315 a-315 c may be outlined in the images 305, 310 to assist inproviding orientation to a user. A menu 230 may be provided to allow auser to easily access commonly used tools such as zoom, pan, and crop,for example. Below images 305, 310, a user may observe a chart of trenddata 340 for the tumor. In the example illustrated in FIG. 3, tumorsurface area has been calculated, but other indicators such as volume orvascularization may be calculated. The area calculated for the firsttime point 320 and the second time point 325 for the tumor may beplotted on the chart 340. In some embodiments, more time points may becalculated and plotted. A line of best fit 355 may be calculated for theplotted time points. A menu 335 may be provided to allow a user toeasily access commonly used tools for manipulating the chart such a zoomand pan. Other tools may also be provided.

Although not shown, a small image (or likeness) of each of other imagesmay be displayed in a smaller format (e.g., as icons) for a user'sconvenience in selecting images. This may be useful when all imagescorresponding with a certain examination or time periods of interest maynot be displayed in the viewing area. Accordingly, a user may select oneof the smaller images to view as an enlarged rendering of the selectedimage. Thus, by selecting an image (e.g., using a double click of amouse, etc.), a user may cause the process to magnify the image.Further, a magnification view setting may be provided so that, selectedviews may be displayed in a window that may be larger than windows whichdisplay the other images (e.g., smaller views, icons, etc.). Further, asshown, when a point of interest such as a blood vessel is detected bythe process, the blood vessel may be automatically assigned anidentifier (ID) and other information. This information may be displayedin association with an image and may be included in the imageinformation and saved for later use.

A screen shot 400 illustrating a further image display according to anembodiment of the present system is shown in FIG. 4. The screen shot 400illustrates image 410 which is a detailed image which corresponds withthe wire frame 305 of FIG. 3. The user may use menu options 430 togenerate a wire frame 405 or render a surface for the acquired volumeimage. A blood vessel 420 can be seen in image 410 within the tumorvolume. A focal zone location indicator bar (not shown) may be displayedon the screen where a user may change it, e.g., via any user interfaceor control panel 38, such as a keyboard, mouse, or a pointer touchingthe screen in case of a touch sensitive screen. The user may also adjustthe image intensity/contrast via selection. Of course, any other desiredindictors or selection bars may be displayed as desired to providefurther user control, such as a scroll/location bar so that the user mayscroll the image. After inputting a user's selection, the image 310 andthe corresponding image information such as, for example, annotations,caliper information, and/or other information may be saved for later useand review. The user may use menu options to calculate the volumes,vascularization index, and/or other parameters of the tumor volumeimages. A side panel 425 may be used to display the calculatedparameters. In the example illustrated in FIG. 4, volume, vascular index(VI), flow index (FI), and vascular flow index (VFI) (in thisembodiment, vascular flow index=vascular index×flow index) have beencalculated using, e.g., the lesion vascularization processor 34 and aredisplayed. The user may then display a plot of the desired parametersover time as shown previously in FIG. 3.

An example screen shot 500 illustrating yet another image displayaccording to the present system is shown in FIG. 5. The screen shot 500shows a first image 502 including a tumor volume 508 a at a first time.Tumor vasculature 506 a can also be identified in a B-mode image andflow of blood can be determined with Doppler imaging. A second image 504is acquired at a second time and displayed with a wire framerepresentation of the tumor volume 508 b. The respective tumor volumesat each time point can be compared. For example, the inset 510illustrates a composite of the wire frame generated in image 502overlaid with the wire frame generated in image 504. A similar approachcan be used for image 305 and 310 above. Although two wire frames areshown, more than two volumes may be overlaid in some embodiments. In theinset or in another area of the display, a calculated volume difference512 can also be shown to the physician to compare different tumorvolumes, such as 508 a and 508 b. Furthermore, tumor vasculature 506 aand 506 b can also be analyzed to indicate where blood supply may beaffected with respect to the tumor size change, e.g., as shown by thearrow 514. It is further envisioned that visual differences 516 in thetumor volumes can be displayed to the user for additional analysis ofthe shape and/or volume change of the tumor over time. Colors or othervisual indicators could be used to identify differences. After inputtinga user's selection, images 502 and 504 and any corresponding informationsuch as, for example, annotations, caliper information, and/or otherinformation may be saved for later use and review. Although not shown,the user may use menu options to calculate the volumes, vascularizationindex, and/or other parameters of the wire frames and plot the valuessimilar to FIG. 3.

Although not shown, the screens 300, 400, and/or 500 may also illustrateuser selections which may include, for example, icons or menu itemswhich may be selected by the user to, for example, scan, file, print,transfer images (e.g., from one display to another), mute, transcribe,and/or use a headpiece, as desired. Further, one or more menus as isknown in the art may be provided for a user's convenience. The displayedimages and associated data may be saved at any time during the processshown in FIG. 1B or during subsequent physician analysis. However, ahistory mode may be activated to gather information indicative of whendata may have been added and/or edited so that a user may refer back tooriginal information and/or determine when and/or who made certainchanges to information which may be saved in, for example, a generatedreport. Further, the changes may also be stored for later use.

Although the present system has been described with reference to a tumorultrasound imaging system, it is also envisioned that the present systemcan be extended to other medical imaging systems where multiple imagesare obtained in a systematic manner at different points in time.Accordingly, the present system may be used to obtain and/or recordimage information related to renal, testicular, breast, ovarian,uterine, thyroid, hepatic, splenic, heart, arterial and vascular system,as well as other imaging applications. Further, the present system mayalso include or more programs which may be used with conventionalimaging systems so that they may provide features and advantages of thepresent system.

Further, the present systems, apparatuses, and methods, may also beextended to any small parts imaging where the clear landmarks can bedefined and reproduced. Further, the present methods may be embedded ina program code which may be applied to existing imaging systems such as,for example, ultrasonic imaging systems. Suitable ultrasonic imagingsystems may include a Philips™ ultrasound system which may, for example,support a conventional broadband linear array transducer that may besuitable for small-parts imaging. Further, analysis techniques such as,for example, QLAB™ may be available on-cart with an imaging apparatus oras a post-processing program which may be run outside of an examinationroom. Further, multiple nodules, anatomical entities such as follicles,or other detectible objects, may be followed using the present system.Further, the method of the present systems may be applied to volumesacquired using transducers such as, for example, 2D array transducers,which may include, for example, X-matrix™ or mechanical transducers.

Certain additional advantages and features of this invention may beapparent to those skilled in the art upon studying the disclosure, ormay be experienced by persons employing the novel system and method ofthe present invention, chief of which is that a more reliable imageacquisition system and method of operation thereof is provided. Anotheradvantage of the present systems and method is that conventional medicalimage systems can be easily upgraded to incorporate the features andadvantages of the present systems, devices, and methods.

Of course, it is to be appreciated that any one of the above embodimentsor processes may be combined with one or more other embodiments and/orprocesses or be separated and/or performed amongst separate devices ordevice portions in accordance with the present systems, devices andmethods.

Finally, the above-discussion is intended to be merely illustrative ofthe present system and should not be construed as limiting the appendedclaims to any particular embodiment or group of embodiments. Thus, whilethe present system has been described in particular detail withreference to exemplary embodiments, it should also be appreciated thatnumerous modifications and alternative embodiments may be devised bythose having ordinary skill in the art without departing from thebroader and intended spirit and scope of the present system as set forthin the claims that follow. Accordingly, the specification and drawingsare to be regarded in an illustrative manner and are not intended tolimit the scope of the appended claims.

1. A medical imaging system comprising code, which when executed, causethe system to: receive first image information corresponding with afirst image acquired at a first time, wherein the first imageinformation includes location information, the first image comprising alesion; receive second image information corresponding with a secondimage acquired at a second time, wherein the second image informationincludes location information, the second image comprising the lesion;render a first wire frame representing a first volume of the lesionbased on the first image information; render a second wire framerepresenting a second volume of the lesion based on the second imageinformation; and overlay the second wire frame and the first wire framebased at least in part on the location information of the first imageinformation and the second image information.
 2. The imaging system ofclaim 1, further comprising an ultrasonic probe configured to acquirevolume image data of the lesion at a selected time.
 3. The imagingsystem of claim 1, wherein the instructions further cause the system todetermine coordinate information corresponding to the locationinformation in the first image information and/or the second imageinformation.
 4. The imaging system of claim 3, wherein the coordinateinformation is based upon calculated image contour information of thelesion as a selected time.
 5. The imaging system of claim 1, wherein thefirst image information and second image information include vascularinformation relating to the lesion, wherein the lesion comprises atumor.
 6. The imaging system of claim 5, wherein the controller isfurther configured to determine a first vascular index based on vascularinformation in the first image information and a second vascular indexbased on vascular information the second image information.
 7. Theimaging system of claim 6, wherein the system further comprisesinstructions that cause the system to compare the first vascular indexto the second vascular index.
 8. The imaging system of claim 7, whereinthe vascular index is the percentage of volume in the lesion thatincludes blood flow.
 9. The imaging system of claim 5, wherein thevascular information is derived from Doppler information.
 10. (canceled)11. (canceled)
 12. (canceled)
 13. (canceled)
 14. The applicationembodied on a non-transitory computer readable medium configured toreceive image information from an ultrasonic probe of claim 1, furthercomprising, code which causes the controller to calculate a surface areaof the first volume and the second volume.
 15. The application embodiedon a non-transitory computer readable medium configured to receive imageinformation from an ultrasonic probe of claim 1, further comprising codewhich causes the controller to plot the surface area of the first volumeand the surface area of the second volume with respect to time.
 16. Theapplication embodied on a non-transitory computer readable mediumconfigured to receive image information from an ultrasonic proble ofclaim 1, further comprising code which causes the controller tocalculate a rate of change of the surface area of the first volume andthe second volume between the first time and the second time. 17.(canceled)
 18. An application embodied on a non-transitory computerreadable medium configured to receive image information from anultrasonic probe, the application comprising: code which causes acontroller to: receive first image information corresponding with afirst image acquired at a first time, the first image comprising alesion; receive second image information corresponding with a secondimage acquired at a second time, the second image comprising the lesion;render a first volume of the lesion from the first image information;render a second volume of the lesion from the second image information;and overlay the second volume and the first volume.
 19. The applicationembodied on a non-transitory computer readable medium configured toreceive image information from an ultrasonic probe of claim 18, furthercomprising code which causes the controller to calculate avascularization indicator for each of the first volume of the lesion andthe second volume of the lesion.
 20. The application embodied on anon-transitory computer readable medium configured to receive imageinformation from an ultrasonic probe of claim 19, further comprisingcode which causes a controller to calculate a difference between thevascularization indicator for the first volume and the vascularizationindicator for the second volume.
 21. (canceled)